Hypertrophic pyloric stenosis: a 331 cases report

Hypertrophic pyloric stenosis [HPS] is a frequent infant disease. Its diagnosis is very easy, based on its classical clinical features and ultrasonography. The aim of this study is to evaluate the management of HPS in the Paediatric Surgery Department of Casablanca over a period of 25 years [1977-2002]. We recorded 331 cases and we compared the management of this pathology before and after 1992. The mean age of diagnosis was 52 day-old before 1992 and 34 day-old after 1992. The diagnosis was based on oesophago-gastric barium swallow before 1992, and only on abdominal ultrasonography after. The surgical incision is umbilical since 1992. Death rates decreased from 8% to 2%, showing improvement of the management of HPS since 1992. This improvement can be achieved through an earlier diagnosis and an adequate medical care before surgery

Pancreas pseudocysts in children: therapeutic alternatives

Pancreatic pseudocysts are rare in child. The aim of this study is to review the experience of the Pediatric Surgery Department of the Casablanca Children Hospital and to evaluate the therapeutic results. We retrospectively reviewed 19 cases of pancreatic pseudocyst. Mean age of children was 8 year-old. The post-traumatic origin was the most frequent etiology. Main clinical symptoms were abdominal pain, vomiting and abdominal mass. Diagnosis was based on abdominal ultrasound and CT scan in 42% of cases. Two patients were only observed with a good outcome. Three patients had percutaneous drainage, six needed an open external drainage and 9 had an open internal drainage with a success rate of 78%. Kystojejunostomy is a reliable technique of treating a PSK. However new techniques of endoscopic and percutaneous drainage may be useful in some indications

[Congenital cysts and branchial fistula of the head and neck: a 148 cases report]

We report our experience of 148 cases of congenital cystic anomalies of the head and neck, operated in a twenty-year period. The goal of this study is to evaluate the frequency of the different anomalies and our diagnostic and therapeutic approach. This retrospective study has analyzed 148 cases of children who had surgery for a congenital cyst or fistula of the head or the neck. Thyroglossal duct cyst was the most frequent anomaly [52.7%]. The diagnosis was mostly clinical without need to further explorations. Surgical repair was well codified and consisted in an excision of 78 thyroglossal cysts, 41 dermoid cysts and 29 branchial fistulas. Six cases of thyroglossal cysts needed redo surgery. Six other patients had non specific complications

[Femoral nerve block for fractured or the femur in children [15 cas]]

The orthopedic treatment of the fractured femoral shaft child is based either on the reduction with plaster immobilization, usually practiced under general anesthesia, or on pulling during 10 days followed of plaster immobilization without any analgesia. The block of the femoral nerve is a simple technic that permits a good quality analgesia after fracture of the femur and can be practiced out operative room. We tried to value the possibility of realization of orthopedic treatment of femoral fractures under block of femoral nerve alone. These are the preliminary it is an open prospective study about 15 children aged from 2 to 9 years, they suffer from fractured femoral shaft. The fracture was insulate, there was no alteration of consciousness and any antalgesis medication has been is realized by an anesthesist doctor or sergeon with admiscture of Xylocaine 1% and marcain 1,5%. The pain, the muscular relaxation and the hemodynamic variation are noticed before during 5,10 and 15 minutes after the achievenement of the block. Finally, we noticed also the quality of recution. The spontaneous pain or this caused by papation of the fractured member disappeared 10 minutes after the achievenement of the femoral block, on average, and the muscular relaxation of the thigh has been obtained 11 minutes later. The pulling of the member with manipulation of the fracture focus permitted to get in all the cases an acceptable, or else anatomic reduction of the fracture. The block of the insulate femoral nerve has been for us an effective method and easy to realize even ambulatory

[Nonoperative treatment of clubfoot] 814 cases

814 feet which have congenital talipes equinovarus of 537 children were followed at the surgical and Pediatric orthopedic clinic of the Casablanca children's hosp ital during the period February 1976 to September1990. 64,2% of the feet were examined during the first three months after birth and 70,4% of the children were masculin. The bilateraly was noted in 51,6% of the cases and 42,3 of the feet were irreducible [classified type III]. 15 cases of congenital dislocation of the hip were associated to clubfoot as well as to other malformations. The functional [orthopedic] treatment was applied at the service since 1980, in the form of manipulations with the utilization of posture splints. 131 feet of 81 children benefited from a series of plasters before hand. The aim of manipulations is to correct the various and the supination at first; the peroneus muscles stimulated by a toothbruch during the second phase. At the end, the equins is corrected in pulling the heel downwards. The Denis Brown splints are borne continuously, and are removed only during their-education sessions or in case of complications. Bearing this equipment needs surveyance on the part of the physiotherapist and the mother. Cutaneous ulceration may appear following the placement of the splints; they decreased markedly during our study thanks to artifices applied by the physiotherapist of the favorable shoes evolution, wearing reversed ankle shoes is permitted during the daytime. For the evolution of results, criteria of a morphological and radiological as well as of a functional nature were assessed. Only 495 feet of 318 children were able to be judged with sufficient retreat: the average period being 5 years. In this way, appraisals were done at birth, and on the third, sixth and tenth month of the functional treatment. The x-rays of the tenth month were particularly decisive; they permitted follow-up on the treatment or else they indicated the necessity for conducting surgery. The global results of the treatment were good in 31,1% of cases. Reviewing the literature allowed a comparative study with our works; thus our results were close to those obtained by Turco [35%] and Seringe [38,7%]; Knowing that all the feet were examined by most of the authors before the 30 th day afterbirth. results obtained were even better [36,5%] when the treatment started during the first three months after birth instead of afterwards [13,7%]; this was the case when the foot was initially reducible [classified type I] [39,7%]. 83,8% the feet classified type II [partially reducible] and treated as type I, responded badly to the treatment. Stiff feet, made flexible by using series of plasters, obtained poor results in 57,3% of the cases. All the feet of group III [with bad results] were proposed for surgery, only 197 were operated of which.56,8% had 8 to 12 months of age. 83,7% of these feet underwent minor surgery of the posteromedial release type

[Place of the hormonotherapy by HCG in treatment of ectopia testis in children]

Although cryptorchidism is known since the antiquity, some of its aspects are still not very clear and its treatment, particularly by hormone doesn't realize the unanimity. In order to codify the indication of HCG in cryptorchidism, a prospective study has been realized at the Infant Surgical Clinic of the Hospital Center lbn Rochd of Casablanca. This study concerned also a group of children treated in a "non codified" way since 1988, in order to analyse better the correlation between clinic and surgery. This study concerned 415 children with 528 ectopia testis. 318 of them have been treated with HCG, 6000 to 12000 UI according to the age. The whole success of hormonotherapy has been about 41%. The parameters that conditionned this success are: the age of the child [children older than 6 have had a better result], the seat of the testis [the lower was the testis, the easier was the success], the testicular mobility and the absence of the peritoeal process. In the case of unsuccess of the hormonotherapy, the surgical act permitted to notice aperirtoneal process undiagnosed clinically [95%], a gubernaculum testis high inserted [95%], a short spermatic pedicle [10%] or an non permeable inguinoscrotal duct [35%]. The analysis of this series and data of litterature permits to recommend HCG in the children from 2 to 10 years old, of whom the testis is palpable, without peritoneal process and with a notable mobility of testis. The other cases must belong to the surgery

[Treatment of Hydatic cyst of the lung in children]

A Conservative treatment was adopted in 340 cases of hydatic cyst of the lungin children The authors relate the results and discuss the well-founded of this attitude. 313 patients totalizing 394 cysts were treated surgically. In 306 cases, the treatment was conservative and consisted either a cystectomy with or without capitonnage of the cavity or a pericystectomy. In 7 cases, the treatment consisted in a regulated exeresis egmentectomy or lobe ctomy. 6 death [1,7 p. cent] were noted, they were due to bronchic fistula in most cases. 37 patients [11,8 P. cent] presented post-operative complications. Global results, compared to other series with high rate of exeresis, show that there is no difference between conservative treatment and regulated exeresis. Otherwise, many fistulas of whom some were responsible of deceases would have been avoided through a more eclectic attitude, adjusted to the nature of lesions. This study allows to precise the surgical attitude to adapt according the nature of the cyst

[ biliary fistulae of hydatid cyst of the liver in the child]

The authors report on a series of 40 cases of biliary fistula complicating hydatic cysts of the liver in the child observed during 15 years. They discuss the frequency of the fistula in the child, its mechanism and treatment. The anatomical and clinical characters of the immediate fistula [30 cases] affirmed by the billions or purulent contain of the cyst or by the visualization of the fistula in peroperative, and secondary fistula [10 cases] complicating healthy but voluminous cysts, were localized in the right side of the liver. All the cysts were treated by resection of the projecting vault with drainage of the covity. The average duration of the exhaustion of the fistula is 20 days with an extreme from 7 to 90 days. Four patients deceased. In the case of the immediate fistula, the mortality and the morbidity are more important as in the adult. Certain measures would permit to decrease the complications which are especially subphrenic abscess and purulent retention in the cavity, and permit to shorten the duration of hospitalization without resorting to agression methods as the pericystectomy

[Hip osteo-arthritis sequelas in infant: classification and therapeutics indications]

From a test of classification with regard to osteo-articular lesions and their functional effect, the authors precise the therapeutic indication through 56 cases of hip osteo-arthritis sequelas in the infant. It's about a retrospective study based on 62 hips trated from 1976 to 1990. The group of increasing gravity has been individualized: a first group of stable and mobile hips required remodeling: a second group of stiff hips treated orthopeadically and a third group of dislocated hips who imposed abstention or artroplasty. The result has been appreciated on joint stability and the evolution of joint articular lesions. All hips of group I have preserved a good stability. In group II, the orthopedic treatment led towards the recovery of a modest mobility towards stiffness without articular fusion or towards surgical arthrodesis. In group III, only 2 good results have been preserved by anthroplasty seven years after. The analysis of observation in retrospect of seven years allowed to note that if the dislocation of the hip should occur it would be done in the first months that follow the stage of the arthritis. This notice led the authors to propose a classification based on the stability of the hip at the sequel stage. This classification allowed, in addition, to guide therapeutic indications

[Idiopathic thrombocytopenic purpura. clinic and therapeutic study]

48 cases of [ITEP] were collected in the CHU Ibn Rochd of Casablanca. Patients aged from 2 and half to 58 years. The initial thrombocytopenia was deep [

Posterior urethral valves. Clinical and radiological aspects

From the study of 14 cases of posterior urethral valves, the authors recall the different clinical aspects which can reveal this malformation and emphasize the baby form which may be misleading. They therefore note that the child's from is more frequent in their series which is explained by the usual diagnostic delay, and the ignoring of this entity. They also recall the modalities of radiological exploration [intraveinous urography, public cystography and ultrasound] as well as the data of endoscopic and urodynamic explorations

[ treatment of hypersplenism in the child by ligation of the splenic artery]

Because of the danger of post-splenectomy infection and the limitations of prophylaxis, and since it is possible to reduce the splenic function while preserving the spleen, the treatment of various hematologic disorders by splenic artery ligation has been attempted in 11 children, among whom 3 under 5 years of age. 3 patients had thalassemia, 4 had hereditary spherocytosis and 4 others suffered from secondary hypersplenism. One patient died of overlooked splenic necrosis. The other patients are well, with an average follow-up of 19 months. The aim of this study is to find out whether the dearterialization produces the expected results and is well tolerated and whether the dearterialized spleen still preserves its ability to protect the host against infection. The satisfactory treatment of hereditary spherocytosis and secondary hypersplenism would indicate that splenic artery ligation offers an alternative to splenectomy, especially in children under 5 years

[Hair strangulation of the penis. Report of 38 cases]

When confronted to a section of the glans in a child, whether or not accompanied by urethral fistula, it is possible to eliminate an accident during circumcision in favour of a strangulation by means of a hair as the cause of the injury: first of all the finding of a hair wound around the penis secundly the time elapsed between circumcision and the discovery of the strangulation symptoms. Reviewing 38 cases treated over 4 years, the authors have aimed at classifying the various resulting wounds into 4 main types which imply different appropriate treatments. The social aspects of this pathology are also investigated: while in some cases the procedure may be traced back to more or less rational motives [haemostasis following circumcision child play or attempt to treat enuresis] many are the cases which can only be the result of ritual or criminal practice

Subacute osteomyelitis in children

The diagnostic difficulties of the subacute hematogenous osteomyelitis are due as much to the lack of infection signs as to the extreme polymorphism of the radiological aspects simulating malignant or benign tumoral processes. The authors report 14 cases of subacute osteomyelitis of the long bones in children [among them, 9 cases of Brodie's abcess]. The diagnosis has been confirmed in 9 patients without surgical biopsy. The recovery, spontaneously or under medical treatment lead the authors to discuss the necessity of a surgical approach [diagnostic and therapeutic] when there are evocative radiological aspects, particularly in a country where osteomyelitis remains frequent

Intervertebral disc clacifications in children. About 2 cases

Two cases of intervertebral space calcifications [cervical and cervico-dorsal] are reported in two 8 year-old children. The evolution spontaneously resolvent illustrates the benignity of this disease in children in spite of an alarming symptomatology and a radiological aspect likely to be worrying

Early surgical treatment of a giant cervico-facial hemangioma

The authors report a case of giant extensive cervico-facial hemangioma resistant to steroid therapy, removed surgically at the age of 4 months

[Oesophagus ligation on a Murphy button in the oesophageal varices in children. Preliminary results]

The author reports the preliminary results of oesophagus ligation on a Murphy button as applied to 5 cases of extra-hepatic portal hypertension in children. In spite of short follow-up, the fact that the patients did not rebleed and the disappearance of the oesophageal varices seem to attest the efficiency of this method for azygo -portal deconnection. Among the two fatal issues of this series, one is related to splenectomy and the other to a stenosis of the oesophagus which was incorrectly treated. Both should be prevented by modifying the management procedure